Art therapists' approaches to the treatment of body image distortion and guilt in sexually-abused girls ages 4, 8, and 13

Abstract:

(Finkelhor, 1986; Haugaard & Dickon Reppucci, 1988) have
concluded that there is insufficient information on how to
treat child sexual abuse (CSA). The reported incidence of
CSA has substantially increased, hence, the need for
treatment approaches has escalated. The purpose of this
study was to provide clinicians who treat CSA with a
descriptive account of the methods currently used by art
therapists to treat sexually-abused children of differing
ages who present with different issues.
One hundred and forty-six certified and/or diplomaed art
therapists, aged 26 to 66, who had training and experience in
CSA treatment were solicited through the national art therapy
associations in Canada and the United States. They responded
to case-simulation surveys which consisted of a case history,
photograph, and self-portrait of a hypothetical sexually abused
girl aged 4, 8, or 13 who presented with either the
issue of body image distortion or guilt. Open-ended or
multiple choice research questions on the art therapist's
treatment approach, choice of media, directives, use of time,
use of therapeutic interactions, use of debriefing process,
opinions on the function of art in the session, and method of
evaluation were utilized to obtain a qualitative description
of the art therapy approach to working with a child of a
certain age presenting with a particular issue.
A content analysis of the qualitative data resulted in
the identification of thematic categories which described the
goals, directives, debriefing process, and the function of
art in the session. The responses to the questions on time
use and media were analyzed similarly. The frequency of
responses for the multiple choice answers and the thematic
categories were calculated and then compared across the age
and issue variables, in the form of percentages. A
comprehensive clinical description of the art therapists'
approaches to CSA treatment was obtained for the whole
sample, and across age, and issue. The subjects' responses
were paraphrased to illustrate these differences for each
question.
The main findings were: (a) art therapists addressed the
main issues of CSA, as described by traditional verbal
therapists (Sgroi, 1982), and employed both directive and
nondirective styles in their approaches; (b) art therapists
were sensitive to the developmental level of the child
depicted in the case simulation and adapted their approach
to meet the child's needs (i.e., the sessions with younger
children were characterized by different media choices,
and directives, the therapists spent more time being
supportive and nurturing, provided physical contact, snacks,
used art-as-therapy, spent less time discussing and more
time playing and doing, allowing the child to work out her
issues through using her body and the media whereas with the
adolescents, art was used as psychotherapy and catharsis more
frequently and discussion and debriefing were utilized to
help change her thinking about the abuse experience), (c)
art therapists responded differently to the body image
distortion and guilt case simulations (i.e., activities
designed to solicit representations of feelings and of the
offender were more frequently reported for the guilt case
simulations while self-portraits and safe places were more
frequent in the responses to the body image distortion
case simulations, and (d) the findings on the function of
art in treating CSA replicated the earlier study by Marrion,
Landell, and Bradley (1988).
This study provided a clinical description of art
therapists' approaches to treating CSA. It illustrated the
function of the art directives, the use of media, the
debriefing process, and the art products themselves. The
descriptions of these may aid clinicians in understanding how
this sample of art therapists worked with sexually-abused
children and may prompt them to undertake training in this
discipline as a way broadening their approach to working with
sexually-abused children.